Insurance

Kimberly Westrich, director for health services research for the National Pharmaceutical Council, explained why accountable care organizations should consider medications an essential part of condition management.

The Government says the site did not carry any personal information on consumers.

Yesterday's government report that healthcare spending will start rising faster after a decade of historically slow growth raises questions: Will rising numbers of insured people drive the spending? Or are healthcare costs going up on their own? The answer is likely some of each, based on a look at trends within yesterday's report and a just-released study of spending by commercial health plans, published in The American Journal of Managed Care.

Implementation of payment reform, without a corresponding change to coverage, benefit, and other payment requirements, creates conflicting incentives that may nullify the intended aim of payment reform: to improve health outcomes, while saving costs.

Two recent policy announcements, one from Medicare and another from the US Preventive Services Task Force, signal a shift toward understanding that America's battle with obesity and diabetes is not only a medical but also a behavioral health problem, and must be treated as such.

Balancing health care tailored to the individual with a modern reimbursement scheme based on population health is the challenge that awaits the nation's healthcare system. Based on a study in The American Journal of Managed Care, it can be done, even among patients like seniors who use more healthcare than most.

This week's news that Aetna would be repaid $8.4 million after uncovering a questionable relationship between three clinics and a hospital has its roots in a well-known managed care reality: If you're treated in a hospital setting, it costs more.

AAFP Board Chair Jeff Cain, MD, of Denver, sent a detailed response to CMS Administrator Marilyn Tavenner, MA, wherein he outlined some specific AAFP suggestions for improving the 2015 fee schedule.

Hospice has long been seen as a solution to achieving both quality of care and cost control at the end of life. The arrival of Medicare Part D has raised concerns that some drugs are paid for twice, but efforts to fix the problem will shift some burdens on to Part D plans, according to The American Journal of Pharmacy Benefits.

In 2003, when President George W. Bush signed the major Medicare expansion that would establish prescription drug coverage, he called it "a promise, a solemn promise, to America's seniors."

The authors demonstrate the utility of distributed data models for reporting of local trends and variation in utilization, pricing, and spending for commercially insured beneficiaries.

This study investigated the impact of an enhanced preventive care delivery system on healthcare expenditure and utilization trends among Medicare Advantage beneficiaries.

The two studies, published in the August issue of JAMA Internal Medicine, examine the pros and cons of the current cancer screening methodologies.

The study, published in the journal Health Service Research, found that the timing of the financial incentives offered by the program was not associated with improved quality of care.

A new Kaiser Family Foundation report analyzes key trends that have shaped the Medicare Part D marketplace since the program launched nine years ago, providing a detailed assessment of changes in plan availability, enrollment, premiums and cost sharing in both private stand-alone drug plans, and Medicare Advantage drug plans.

The final decision on the proposal will be made only after a 30-day comment period.

HHS said that many Medicare Advantage plans wrongly inflated patient risk scores, costing the government billions. Although no insurers were specifically named, HHS researchers said it was evident that the practice of overbilling was occurring industry wide.

Next year, U.S. healthcare providers will be subject to Medicare penalties if they do not meet up to 26 measures for value-based purchasing.

The CMS has removed the provider review version of a new database that details financial relationships between healthcare providers and drug and medical-device manufacturers.

High rate of hospice survivors, especially in Alabama and Mississippi, have raised doubts about improper practices.

The federal government this month quietly stopped publicly reporting when hospitals leave foreign objects in patients' bodies or make a host of other life-threatening mistakes.

The pharmacy benefit manager has decided to choose formulations that provide equivalent benefit at lower cost.

According to a recent survey, hospitalists said that the 2-midnight rule is negatively impacting patient care as well as patient finances.

CMS has announced that it will nearly double the number of candidates in its bundled payment program. As part of the Affordable Care Act, the program aims to reduce care costs and improve patients' quality of care by offering providers with an alternative to the traditional fee-for-service reimbursement model.

A study just published in The American Journal of Managed Care examined how benefit design differences affected seniors who received prescription coverage through Medicare Advantage compared with a stand-alone Medicare drug plan. The review showed that integrating drug coverage with medical care resulted in fewer barriers to name-brand drugs, with lower copayments.

Active implementation of cost-saving measures successfully cut down expenditure at the Norris Comprehensive Cancer Center.

Uncompensated care was supposed to be a thing of the past, but it's persisting in many states not expanding Medicaid eligibility. As an alternative, for some high-cost uninsured patients, hospitals are turning to a new option.

To better align the care of beneficiaries insured under both the Medicaid and Medicare programs, CMS invited states to participate in a 3-year demonstration project. However, it seems that many beneficiaries have opted out of these care coordination programs that are offered across the country.